Factors associated with adherence to infectious diseases advice in two intensive care units
Factors associated with adherence to infectious diseases advice in two intensive care units
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DOI：
10.1093/jac/dki483
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发表时间：
2006-03-01
影响因子：
5.2
通讯作者：
Roger, PM
中科院分区：
文献类型：
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作者：
Pulcini, C;Pradier, C;Roger, PM
目的：已有多项研究报道，只要依从性足够，传染病会诊可以提高抗生素处方的质量。这项研究的目的是确定与坚持此类治疗建议相关的因素。患者和方法：我们在两个重症监护病房(ICU)进行了一项为期6个月的前瞻性研究。结果：共记录患者381次咨询，A区244次(%)，B区137次(36%)，SAPS评分中位数为45分，病死率为23%。感染占入院人数的220人(58%)。在125例(33%)病例中，发现ID和重症监护专家之间的诊断不一致。ID专家建议138例(36%)继续使用相同的抗生素治疗，154例(41%)改变，89例(23%)停用。326例(86%)患者遵守ID治疗建议。多因素分析发现两个独立影响依从性的因素：B区[优势比(OR)，4.9；95%可信区间(CI)，2.0~12.1]和寻求相同治疗的主张(OR，4.8；95%CI，1.6~14.5)。结论：患者的特征和抗生素治疗方式不影响患者对ID咨询的依从性。相比之下，病房及其特点在坚持ID建议方面发挥着重要作用。
Objectives: Several studies have reported that infectious diseases (ID) consultations improve the quality of antibiotic prescription, providing adherence is adequate. The aim of this study is to determine the factors associated with adherence to such therapeutic advice.Patients and methods: We conducted a prospective study in two intensive care units (ICUs) over a 6 month period. Systematic bedside diagnostic and therapeutic ID advice was delivered for all patients receiving antibiotic therapy.Results: A total of 381 consultations for 195 patients were recorded, 244 (64%) in ward A and 137 (36%) in ward B. The median SAPS score was 45 and the mortality rate was 23%. Infections accounted for 220 (58%) admissions. A diagnostic discrepancy between ID and intensive care specialists was noted in 125 (33%) cases. The ID specialist advised continuation of the same antibiotic therapy in 138 (36%) cases, a change in 154 (41%) and withdrawal in 89 (23%). Adherence to ID therapeutic advice was recorded for 326 (86%) cases. Multivariate analysis identified two factors independently associated with adherence: ward B [odds ratio (OR), 4.9; 95% confidence interval (CI), 2.0-12.1] and proposition to pursue the same therapy (OR, 4.8; 95% CI, 1.6-14.5).Conclusions: Patients' characteristics and antibiotic therapy modalities do not influence adherence to ID consultation. In contrast, the ward and its characteristics play a major role in adherence to ID advice.